New limits on medical and nursing school loans worry health educators : Shots

A little-noticed provision in the sweeping One Big Beauty Act passed by the GOP over the summer sharply limits the amount of federal student loans that students pursuing professional degrees, including medical schools, can borrow.

It also imposes even stricter limits on borrowing for other areas of health care, including nursing and public health. The Department of Education does not consider postgraduate education in these areas. “professional” educationalthough officials described it as technical and regulatory solution, not a value judgment.

The loan changes will come next July when the federal open lending program known as Grad PLUS will stop issuing new loans. Effective immediately, medical students will not be able to borrow more than $50,000 per year or more than $200,000 over four years. Many private medical schools already cost over $300,000, including living expenses.

“This will automatically give a lot of people some pause to think about where they are being accepted and what their finances are,” said Vineet Arora, associate dean for education at the University of Chicago Pritzker School of Medicine.

Given that most medical students already belong to the top 40% of family income, Arora added, “we already have fewer medical students from middle-class and low-income families.” Lack of access to credit could further distort the situation, she said.

In addition to these new restrictions, a federal regulation was published on October 30 that is already summons – adds new conditions to Government Service Loan Forgiveness A program that allows healthcare workers who work in high-need areas to make payments over 10 years to pay off the debt.

The Trump administration's new policy says loan forgiveness will not be an option for people working for an organization engaged in, among other things, illegal activities related to immigration, gender-affirming care or “terrorism” aimed at “obstructing or influencing” federal policy. The Minister of Education will decide which organizations will not be eligible.

These restrictions on how aspiring doctors or other health care providers — nurses, occupational therapists, social workers, dentists and many others — can finance their education likely foreshadow a richer and less diverse health care workforce in the future, said Atul Grover, who recently stepped down from his longtime policy post at the Association of American Medical Colleges. He is now a visiting scholar at Stanford and a consultant to the healthcare sector.

But supporters of the legislation, including Senate HELP Committee Chairman Sen. Bill Cassidy, who advanced a version of the legislation earlier this year, argue it would lead to changes in higher education funding that would lower the cost of tuition and protect people starting their careers from “drowning in debt.”

These new credit changes add to a slew of recent court decisions and administrative policies that have stifled diversity, equity, and inclusion initiatives in higher education.

Grover said the new policy will “disproportionately discourage and make it less likely” that students from low-income families will attend — or even apply — to medical school.

“Once you tell them, 'Oh, you're going to have to borrow $300,000 to get into medical school,' they're like, 'Well, that's the end of it, right?' Grover said.

Narrowing down who can afford medical education

From the momentous June 2023 Supreme Court decision prohibit race from being taken into account in admissions, black and Hispanic admission to medical schools fallen.

This trend, as well as new Trump administration policies, could mean there are fewer young doctors practicing in underserved communities, both rural and urban. Some new doctors will, of course, still choose to practice there, including those who themselves grew up in such communities. But many may feel like they have to choose high-paying specialties over primary care to get out of the debt pile.

The Association of American Medical Colleges said the new loan limits will likely worsen the physician shortage, which is projected to reach 86,000 physicians by 2036 — on top of existing shortages of physicians in underserved communities.

“If future medical students face greater financial barriers—especially those from low-income, rural, or first-generation backgrounds—we risk reducing the number of qualified applicants. Fewer students entering medical school now means fewer residents and practicing physicians in the future,” the AAMC said in an emailed statement.

The AAMC declined to comment further, as did several administrators and medical school officials.

According to the Department of Education, the changes will affect not only doctors, but also dental students, as well as students in various pharmaceutical and psychological specialties that are considered professional, as well as chiropractors and podiatrists. memo.

But college-educated nurses, as well as medical practitioners such as occupational therapists and physical therapists, are not included in this list. And for these “non-professional” graduate schools, the annual loan limit will be $20,500. Organizations representing these practices hope to push for some policy changes before the rules are finalized, but they have had little success after months of debate.

“Disinformation on TikTok has caused confusion about the Trump administration's ongoing actions to impose restrictions on student loans for graduate students,” Elle Keast, a spokeswoman for the Department of Education for Higher Education, said Monday. “The Trump Administration is introducing long-needed restrictions on graduate loans to reduce the cost of programs.”

The nurses disagree.

“At a time when our nation's healthcare system faces a historic nursing shortage and growing demands, limiting nurses' access to graduate education funding threatens the very foundation of patient care,” American Nurses Association President Jennifer Menick Kennedy. says the statement. “In many communities across the country, especially in rural and underserved areas, advanced practice registered nurses provide access to essential, high-quality care.”

The benefits of a diverse healthcare workforce

Making postgraduate training in health professions less attainable could change the composition of the health care workforce.

This contradicts growing evidence outlined in a major report last year from the National Academies of Sciences, Engineering and Medicine called Ending unequal treatment that a healthcare workforce that looks like America is actually good for America's health.

It's not that a white doctor or nurse can't provide excellent care to a black, Hispanic, or Asian patient—or vice versa. This happens every day. But shared experiences and racial, linguistic and cultural matches between patient and health care provider, known as “concordance,” can improve doctor-patient communication. Some evidence shows that it improves patients' ability to cope with chronic diseases such as diabetes or hypertension.

“The data suggests that when we have a diverse and inclusive workforce that is representative of the population served, we actually see improvements in health outcomes,” said Vincent Guilamo-Ramos, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, who served on the National Academies panel.

“Across all health professions,” he said, “we see an underrepresentation of people who need health care providers who can bring their lived experience to their practice.” This may include spoken languages ​​in addition to English to improve communication with patients.

According to the AAMC and its Osteopathic Medicine counterpart. reported in JAMA Network Open, since the Supreme Court decision in 2023, enrollment of black or African American students has fallen 11.6% and Hispanic enrollment has fallen 10.8%. Enrollment of Asian and white students has increased.

A number of universities offer a variety of advanced education programs to help high school students and even younger children explore and prepare for careers in science and medicine. Some are still ongoing and are structured to avoid violating DEI regulations.

But the approach medical schools have taken since the Supreme Court, sometimes called “holistic admissions,” has met resistance from the Trump administration. The idea was to take a broad look at medical school applicants—for example, those who may have overcome adversity, rather than just those with the highest MCAT scores.

It was encouraged under the Biden administration. But President Donald Trump released “presidential memorandum” outlining how the Department of Education should combat “overt and covert racial proxies.”

“Greater transparency is necessary to expose illegal practices and ultimately rid society of a shameful and dangerous racial hierarchy,” Trump wrote.

However, many health educators say the main problem is the high cost of education in health fields.

Proponents of the changes, including Cassidy and the Department of Education, argue that with borrowing limited, pressure will mount on schools to cut tuition.

But some education officials say that while they too would like to see education become more accessible, they don't think such policies will achieve that. With support for the NIH under threat, endowment taxes rising at some large, prestigious universities, and animosity between the administration and elite institutions, help is unlikely, Guilamo-Ramos said.

But more accessible education, he said, would be beneficial for both students and patients.

“One of the ways we can optimize everyone's health and save money is by making sure we have the best workforce, which means it should be representative, and then motivating people, all kinds of people, to pursue a career in health care, not just the one that would be the most lucrative.”

Joan Koenen is a journalist in residence at the Johns Hopkins Bloomberg School of Public Health.